Dynamic representation of multipolar leads in a programmer interface

ABSTRACT

An external programming system for programming an implantable medical device includes a user display and a memory storing multiple intracardiac lead images. The intracardiac lead images correspond to lead types and includes electrodes spaced according to the spacing of electrodes of a particular lead type. The programmer selects one of the lead images for display based on an indication of which type of lead has been implanted in a patient. The selected image is displayed to a user as part of a graphical user interface for programming cardiac pacing therapy for the patient.

TECHNICAL FIELD

The invention relates to programming of implantable medical devices and,more particularly, to representation of cardiac leads in the userinterface of a programmer

BACKGROUND

Implantable medical devices (IMD), such as pacemakers or other cardiacdevices, may be used to deliver electrical stimulation therapy to apatient's heart to treat a variety of symptoms or conditions, such asheart failure and arrhythmia. In general, an IMD delivers cardiacstimulation therapy in a form of electrical pulses. An IMD may delivercardiac stimulation therapy via one or more leads that include one ormore electrodes located within in or proximate to the heart.

In general, a physician selects values for a number of programmableparameters in order to define the electrical cardiac stimulation therapyto be delivered by the IMD to a patient. For example, the physicianordinarily selects a combination of electrodes carried by one or moreimplantable leads, and assigns polarities to the selected electrodes. Inaddition, the physician may select an amplitude, which may be a currentor voltage amplitude, and a pulse width for stimulation pulses to bedelivered to the patient. The physician may also select chambers of theheart to which therapeutic stimulation should be delivered, select amode of cardiac pacing, select a progression of anti-tachyarrhythmiatherapies, and select values for a number of other programmableparameters, such as escape, atrioventricular, or inter-ventricularintervals.

SUMMARY

In general, the disclosure is directed to the depiction of multipolarintracardiac leads including an electrode spacing/locationconfiguration. In some examples, the intracardiac leads depicted arequadripolar leads. In some examples, a programming device receives anindication of a type of lead, depicts one of a plurality of lead imageshaving different electrode configurations based on the selected type. Bydisplaying a lead image with a more accurate representation of theelectrode configuration of the actual lead implanted in the patient, aprogrammer may facilitate more efficient programming of vectors forstimulation or sensing by a user.

In one example, the disclosure is directed to a method includingretrieving, from a memory storing a plurality of intracardiac leadimages, a selected lead image, the lead image selected based on anindication of a lead type, and displaying the selected lead image,wherein the selected lead image includes a plurality of electrodesspaced according to spacing of electrode on the lead type.

In another example, the disclosure is directed to a system including auser display, a memory configured to store a plurality of intracardiaclead images, each of the lead images associated with a respective one ofa plurality of lead types, and each of the lead images including aplurality of electrodes spaced according to the spacing of electrodes ofthe associated lead type, an interface configured to receive anindication of which of the plurality of lead types corresponds to a leadof a patient, and a processor configured to choose the one of the leadimages that is associated with the indicated lead type, and provide thechosen image to the user display for display as part of a graphical userinterface for programming cardiac pacing therapy for the patient.

In another example, the disclosure is directed to a system includingmeans for receiving an indication of a lead type, means for retrieving alead image selected based on the indication of lead type from aplurality of intracardiac lead images, and means for displaying theselected lead image, wherein the selected lead image includes aplurality of electrodes spacing according to spacing of electrodes onthe lead type.

The details of one or more examples are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a conceptual diagram illustrating an example system thatprovides therapeutic electrical stimulation to the heart of a patient.

FIG. 2 is a conceptual diagram illustrating an example programmer forprogramming an implantable medical device.

FIG. 3 is a schematic diagram illustrating an example user interfacepresented by the example programmer of FIG. 2.

FIGS. 4A-4D are schematic diagrams illustrating example user interfacesincluding an example lead image.

FIG. 5A-5C are schematic diagrams illustrating example graphical userinterfaces including an example lead image.

FIG. 6 is a flow diagram illustrating an example method of electrodeselection consistent with various examples in this disclosure.

FIG. 7 is a flow diagram illustrating another example method consistentwith the present disclosure.

DETAILED DESCRIPTION

In various examples consistent with this disclosure, an implantablemedical device (IMD) intended to provide pacing or other cardiacstimulation, as well as sense electrical activity of the heart, may beimplanted within a patient. The IMD may be coupled to a number of leadsthat extend into and around the patient's heart. Each of the leads mayinclude any number of electrodes. Leads with multiple electrodes may bereferred to as multipolar leads.

Two or more electrodes on one or more of the leads may cooperate toprovide stimulation at a particular location or region of tissue. A“vector” for stimulating the location or region may refer to the two ormore electrodes, as well as the polarity of the electrodes or resultingdirection of the stimulation. The various electrodes on the leads may beprogrammed individually to provide stimulation at a number of differentlocations and with a variety of vectors. Similarly, two or moreelectrodes on one or more of the leads that cooperate to senseelectrical activity, e.g., from a particular chamber of heart, may bereferred to as a sensing vector.

In some examples, one or more of the cardiac leads implanted within thepatient is a left ventricular (LV) quadripolar lead. The LV quadripolarlead provides a total of four electrodes and the capability to programall four electrodes as a cathode or an anode. This flexibility inprogramming provides numerous possible LV vectors, each of whichincludes at least one electrode configured as an anode and at least oneelectrode configured as a cathode. In some examples, vectors includingtwo or more anodes or two or more cathodes, resulting in greater anodaland/or cathodal surface area, are used. A physician that has implantedthe LV quadripolar lead may want to test one or more of the potentialvectors to determine which of the numerous vectors is most effective forthe patient.

The sixteen or more vector choices provided by an LV quadripolar leadresult in a relatively complex vector selection process when an LVquadripolar lead is implanted. In addition, different multipolar leadmodels may have a variety of different spacings between the electrodes,e.g., spacings between the four electrodes of a quadripolar lead. Thesize, shape and/or location of the electrical field resulting fromdelivery of an electrical stimulation via a vector may vary based on thespacing of the electrodes on a multipolar lead, and thus the spacingbetween the electrodes of the vector. It may be helpful to a clinicianto have an accurate depiction of the type of multipolar lead, e.g.,quadripolar LV lead, implanted in a patient, with an accurate depictionof the spacing between the electrodes of the lead, i.e., the positionsof the electrodes on the lead. The depiction may influence the choice ofa vector, and the order in which vectors are tested. In some examples,the multipolar lead may have more or less the four electrodes of aquadripolar lead. For example, a lead may have three or five electrodes.

In order for a programmer user interface to show a graphical depictionof an implanted lead with appropriate electrode positions and spacing, auser may choose an appropriate graphic corresponding to the multipolarlead model that has been implanted. In some examples, the user mayselect a graphic from a number of graphics stored within the programmerbased on an image that represents the graphic. In some examples themultipolar lead may include four electrodes. In other examples themultipolar lead may include more or less electrodes. For example, a leadmay include 3 or 5 electrodes. The graphic displayed on the userinterface may include the appropriate number of electrodes, as well asappropriate positioning and spacing of the electrodes. Many of theexamples below refer to a quadripolar lead; however, the examples may beapplicable to multipolar leads with any number of electrodes greaterthan one.

In some examples, the user may select a graphic by providing a leadmodel or serial number. For example, the user may manually input thelead model or serial number. In other examples, the programmer may becoupled to a scanner. The scanner may read a barcode, radiofrequencyidentification (RFID) tag, or another identification element from on thelead or a lead package. In other examples, the scanner may scan apatient identification element, which may itself indicate the type oflead that has been implanted, or may provide a patient identificationthat allows the type of lead that has been implanted to be retrievedfrom database of patient information.

The user may then program the therapeutic stimulation and sensing forthe patient, e.g., choose electrodes for one or more vectors to test.The graphic of the lead may be modified to depict the selection. Forexample, the graphic may highlight the electrodes chosen, as well asindicate whether the chosen electrode is being programmed as an anode ora cathode. In some examples, the graphic may be modified to depict theresulting vector as well.

In some examples, a user may choose a graphic that includes an electrodeconfiguration that approximates the electrode configuration of animplanted lead. The user may select from a set of graphics includingcommon electrode spacing configurations. For example, a programmer maypresent lead images with a variety of electrode spacing configurationsincluding dual tight electrodes, where there are two electrodes closetogether near the tip, and a second set of electrodes close together ata distance away from the electrodes close to the tip. Another lead imagemay depict an electrode configuration with a tight middle spacing. Suchan electrode spacing configuration may include an electrode near the tipof the electrodes, a space, two electrodes close together, another spaceand the fourth electrode. Another lead image may depict an electrodespacing configuration with equal spacing between the four electrodes.Another lead image may depict an electrode spacing configuration wherethere are two electrodes closely spaced near the tip and then the othertwo electrodes have a greater space between each other and between themand the first two electrodes. Another lead image may depict an electrodespacing configuration with wide unequal spacing between the fourelectrodes. For example, in a quadripolar lead including electrodesLV1-LV4, the electrodes may be spaced to such that there are 10millimeters (mm) between LV1 and LV2, 20 mm between LV2 and LV3 and 15mm between LV3 and LV4.

In some examples, the user may also be able to modify the electrodespacing. For example, a user may select from among a plurality ofpredefined lead images that approximate most multipolar lead electrodespacing configurations. The user may then select one or more of theelectrodes and move it on the lead image to provide a betterapproximation of the configuration of the actual lead implanted withinthe patient.

In some examples, a programmer may have a default display of equalspacing between the electrodes. The user may modify the spacing toapproximate the spacing of the electrodes of the lead implanted withinthe patient. In some examples the user may be able to save a lead imagewith the modified spacing in order to retrieve the lead image for usewhen the same lead type has been used in another patient.

In some examples, a lead image may include features in addition to theelectrode spacing configuration. For example, the lead image may depictwhether the lead that was implanted was a straight or canted lead. Insome examples, the lead image may also include a depiction of thelocation of fixation points, e.g., a depiction of the type, such asstructure, and location of a fixation mechanism. Although the examplesbelow are discussed primarily with respect to programming of LVquadripolar leads, other multipolar leads, such as atrial or RV leads,with the same or a different number of electrodes, may also beprogrammed.

FIG. 1 is a conceptual diagram illustrating an example system 10 thatprovides electrical stimulation to heart 12 of patient 14. System 10includes implantable medical device (IMD) 16, which is connected toleads 18, 20, and 22, and is communicatively coupled to a programmer 24.IMD 16 senses electrical signals attendant to the depolarization andrepolarization of heart 12, e.g., a cardiac electrogram (EGM), viaelectrodes on one or more leads 18, 20 and 22 or the housing of IMD 16.IMD 16 may also deliver therapy in the form of electrical signals toheart 12 via electrodes located on one or more leads 18, 20 and 22 or ahousing of IMD 16. The therapy may be pacing, cardioversion and/ordefibrillation, which may be delivered in the form of electrical pulses.IMD 16 may similarly include or be couple to other sensors, such as oneor more accelerometers, for detecting other physiological parameters ofpatient 14, such as activity or posture.

Leads 18, 20, 22 are intracardiac leads that extend into the heart 12 ofpatient 14 to sense electrical activity of heart 12 and/or deliverelectrical stimulation to heart 12. In the example shown in FIG. 1,right ventricular (RV) lead 18 extends through one or more veins (notshown), the superior vena cava (not shown), and right atrium 26, andinto right ventricle 28. Left ventricular (LV) coronary sinus lead 20extends through one or more veins, the vena cava, right atrium 26, andinto the coronary sinus 30 to a region adjacent to the free wall of leftventricle 32 of heart 12. In some examples, LV lead 20 is a quadripolarlead with electrodes LV1-LV4. Right atrial (RA) lead 22 extends throughone or more veins and the vena cava, and into the right atrium 26 ofheart 12.

In some examples, programmer 24 takes the form of a handheld computingdevice, computer workstation or networked computing device that includesa user interface for presenting information to and receiving input froma user. A user, such as a physician, technician, surgeon,electro-physiologist, or other clinician, may interact with programmer24 to retrieve physiological or diagnostic information from IMD 16. Auser may also interact with programmer 24 to program IMD 16, e.g.,select electrodes through which to apply electrical stimulation. Theuser interface may include a display that allows the user to visualizethe electrode spacing configuration of the lead 20 that has beenimplanted, for example.

IMD 16 and programmer 24 may communicate via wireless communicationusing any techniques known in the art. Examples of communicationtechniques may include, for example, low frequency or radiofrequency(RF) telemetry. Other techniques are also contemplated. In someexamples, programmer 24 may include a programming head that may beplaced proximate to the patient's body near the IMD 16 implant site inorder to improve the quality or security of communication between IMD 16and programmer 24. In some examples, programmer 24 may be locatedremotely from IMD 16, and communicate with IMD 16 via a network.Programmer 24 may also communicate with one or more other externaldevices using a number of known communication techniques, both wired andwireless.

FIG. 2 is a conceptual diagram illustrating an example programmer 24 forprogramming IMD 16. In the example of FIG. 2, programmer 24 includesprocessor 88, memory 90, telemetry interface 108 and user interface 98.In general, a user, i.e., a physician or clinician uses programmer 24 toprogram and control IMD 16.

In the example of FIG. 2, memory 90 stores images of a variety of leads92. The lead images include an array of electrode spacing options. Insome examples, leads 92 stores images of lead combinations as well. Forexample, leads 92 may store multiple images including the same electrodespacing configuration on LV lead 20, each with a different RV lead 18.RV lead 18 may have one or more of an RV tip electrode, an RV ringelectrode and an RV coil electrode.

In some examples, the lead images are identified in leads 92 by leadname or serial number. In some examples, the lead images are identifiedin leads 92 by approximate electrode spacing. In some examples, the leadimages are stored in a directory structure or the like based onapproximate electrode spacing. For example, leads having even electrodespacing may be stored together, leads having a close spacing near thelead tip may be stored together, and leads having a close center spacingmay be stored together.

Memory 90 may store program 94 including operational parameters thatspecify possible therapy and sensing parameters for download to IMD 16.As examples, therapy parameters may include pulse width and amplitudefor pacing pulses, as well as values for various intervals that controlthe delivery or non-delivery, and the timing, of pacing pulses. Memory90 may also store program instructions that, when executed by processor88, control processor 88 and programmer 24 to provide the functionalityascribed to them herein. Memory 90 may include any volatile,non-volatile, magnetic, optical, or electrical media, such as a randomaccess memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM),electrically-erasable programmable ROM (EEPROM), flash memory, or anyother digital media. Memory 90 may comprise a tangible computer-readablestorage medium, e.g., a non-transitory medium.

Memory 90 may also record efficacy information 96 for particularprograms 94 in combination with information identifying the electrodesselected by a user for a particular lead 92, e.g., the vector selectedfor the delivery of therapeutic stimulation. In some examples processor88 may determine the efficacy of a particular electrode combination,e.g., vector, based on cardiac signals received from IMD 16 viatelemetry interface 108. In some examples the cardiac signals may beelectrogram (EGM) signals. In some examples the cardiac signals may beheart sounds-based signals. In some examples, the efficacy information96 may include information received from the user. For example, the usermay provide information regarding previous results using a particularelectrode grouping. In this manner, over time different electrodegroupings for a particular lead type may be rated in terms of efficacyso that the user ultimately may select an effective electrodecombination and stimulation parameters. Over time, the programmer 24 maybe able to suggest electrode combinations based on previous outcomes.

A user interacts with processor 88 via user interface 98 in order toidentify a lead image that corresponds to the lead implanted withinpatient 14. The user also interacts with the user interface to select anelectrode or electrode combination to provide stimulation. Processor 88may provide display 100, i.e., a graphical user interface (GUI), viauser interface 98 to facilitate interaction with the user. Processor 88may include a microprocessor, a microcontroller, a DSP, an ASIC, anFPGA, or other equivalent discrete or integrated logic circuitry. Theuser interface 98 may include display 100 and one or more input media106. In addition, the user interface may include lights, audible alerts,or tactile alerts.

The programmer 24 may include a number of input media 106. In someexamples, programmer 24 may include a keyboard. In some examples, theinput media 106 may include a barcode scanner. In some examples, theinput media 106 may be a touch screen.

In some examples, processor 88 may control IMD 16 via telemetryinterface 108 to test selected electrode combination by controlling astimulator within IMD 16 to deliver cardiac stimulating pulses to heart12 via the selected electrode combinations. In particular, processor 88transmits programming signals to IMD 16 via telemetry interface 108.

After completion of electrode testing, processor 88 may transmit theoperational parameters, e.g., vector(s), selected by the physician toIMD 16 via telemetry interface 108 for storage in the IMD 16. Theselected vectors may be used to deliver therapy chronically or over anextended period of time.

Programmer 24 may be provided in the form of a handheld device, portablecomputer or workstation that provides a user interface to a physician orpatient. The physician interacts with user interface 98 to programstimulation parameters for IMD 16 via external programmer 24.

FIG. 3 is a schematic diagram illustrating an example user interfacethat may be presented by example of programmer 24 of FIG. 2. Screen 114is an example GUI that may be presented by user interface 98 of FIG. 2,which may provide a number of different screens and interactivepossibilities. For example, user interface 98 may include a touchscreen, and a physician may be able to make selections using a finger orother pointing device. Screen 114 may be a “home” or start screen forexample. Screen 114 may include a number of icons that lead toadditional screens. The additional screens may present information,programming capabilities, or both.

In response to selection of lead selection function 116, e.g., via ashortcut or other interactive element on screen 114, programmer 24 maypresent a lead selection screen similar to screen 118. In some examples,lead selection screen 118 may be a pull-down screen or pop-up screenthat appears along with the icons of screen 114. In some examples, leadselection screen 118 may replace home screen 114.

In the example of FIG. 3, screen 118 includes lead images 120, 122, 124and 126. Lead image 120 depicts a lead including wide, even spacingbetween the four electrodes of a quadripolar lead. Lead image 122depicts a quadripolar lead including double short spacing. That is, twoelectrodes close together near the tip of the lead and two electrodesclose together a distance away from the tip. Lead image 124 depicts aquadripolar lead with short middle spacing of the electrodes. That is, alead with an electrode at the tip, a large space, two electrodes closetogether, and another large space. Lead image 126 depicts a quadripolarlead having a short tip spacing. That is, a lead with an electrode atthe tip and another electrode close to the tip electrode with a largespace before the next electrode, and another large space before thefinal electrode.

In some examples, a physician may select a lead image showing electrodespacing that approximately corresponds to the electrode spacing of thelead implanted in patient 14 based on the images on lead selectionscreen 118. In some examples, lead selection screen 118 may be anintermediate screen between the home screen 114 and a selection screenthat includes a number of lead images that correspond to actual leadsthat may be implanted in a patient 14. Each of the lead images 120, 122,124 and 126 may lead to a display screen including lead images withapproximately the same lead spacing as those depicted on screen 118. Insome instances the lead images may include not only the approximate leadspacing of the lead the image represents, but a final fixationconfiguration. For example, the lead images may depict a canted lead, orthe placement of fixation points. In some examples the lead images maybe associated with a lead model name or serial number. In some examples,after a lead image has been chosen, a user may then select one or moreof the electrodes depicted to use when delivering cardiac electricalstimulation. The image of the lead including the relative spacing of theelectrodes as implanted in the patient may be helpful to a physician indetermining which electrodes to test first.

Screen 114 may include one or more of the icons 128, 130, 132, 134, 136,and 138. In some examples patient information 128 may includeinformation regarding a patient including, for example, patient name,history, date of birth, hospital ID, the types of leads implanted, thetype of stimulation that is to be provided, or the patient diagnosis. Insome examples choosing parameters 130 brings a user to a screen thatallows the user to program various therapy and sensing parameters,including selecting vectors for delivery of therapeutic stimulation andsensing. In some examples, if a lead image has been selected from thelead selection screen 118, the screen displayed in response to the userselecting parameters 130 may include the lead image selected to enable auser to select desired electrodes or electrode combinations for vectorprogramming In some examples a lead image may indicate which electrodeshave been selected. In some examples, the image may include anindication of a stimulation or sensing, e.g., pacing, vector resultingfrom the electrodes selected.

After an electrode has been selected and pacing parameters have beenset, a physician may test the chosen parameters. These tests may be doneby selecting the tests 138 icon, for example. In some examples, the testicon brings up a display screen that allows a user to select from one ormore preprogrammed tests sequences. In some examples, the test resultsmay be displayed. In some examples, the screen may display an EGM signalas the test is being conducted.

In some examples, the display screen 114 may also include icons forreports 134, data 136 and a checklist 132. Checklist 132 may include achecklist to ensure that appropriate tests of IMD 16 are completed. Insome examples, checklist 132 may include a checklist to ensure that apredetermined number of vectors have been tested. In some examples, thechecklist 132 may include a checklist for a clinic to ensure all tasksassociated with the patient are completed before discharge. Selection ofchecklist 132 may result in display of a graphical user interface thatincludes a number of checklists. Some of the checklists may be relatedto programming IMD 16, while other checklists may be related to overallpatient care.

In some examples, selection of data 136 may result in user interface 98displaying patient diagnostic data or data associated with the integrityof the system. In some examples data 136 may include a list of varioustype of data associated with the IMD 16 and the patient 12. For example,data 136 may include data relating to trends regarding impedance,sensing, or capture threshold trends.

In some examples, display screen 114 may also include reports 134.Selecting reports 134 may result in a display screen including a varietyof reports that may be generated by programmer 24. The reports mayinclude, for examples, report related to patient diagnostics, efficacyof a chosen vector over time, the integrity of the system, changes inefficacy of provided stimulation since previous programming, patientclinical data, patient information or changes made during a follow-upsession

FIGS. 4A-4D are schematic diagrams illustrating example lead images 140a-140 d that may be presented by user interface 98 as part of aprogramming screen in response selection of one of lead images 140 a-140d and selection of programming interface such as tests screen 138 orparameters screen 130 from home screen 114. The lead image 140 includesan image of IMD 16 connected to a LV lead 20 and RV lead 18. LV lead 20includes four electrodes LV1-LV4. RV lead 18 includes a singleelectrode, RV coil. In some examples, not shown, RV lead 18 may includeone or more of an RV tip electrode, an RV ring electrode and an RV coilelectrode. Due to the number of electrodes on quadripolar lead 20, thereare a number of possible electrode combinations, or vectors, for theapplication of stimulation to or sensing of the heart 12. Each of theelectrodes LV1-LV4 has the possibility of being programmed as an anodeof a cathode. Accordingly there are a number of LV pacing and sensingvectors that may be tested during implant and follow-up appointments.

The vectors may include a number of bipolar vectors, such as: thecombination of LV1 and LV2, with either LV1 or LV2 programmed as theanode and the other programmed as the cathode; the combination of LV2and LV3, with either LV2 or LV3 programmed as the anode and the otherprogrammed as the cathode; LV3 and LV4 with either LV3 or LV4 programmedas the anode and the other programmed as the cathode; LV1 and LV4 witheither LV1 or LV4 programmed as the anode and the other programmed asthe cathode; LV2 and LV4, with either LV2 or LV4 programmed as the anodeand the other programmed as the cathode; LV1 programmed as a cathode andRVcoil programmed as an anode LV2 programmed as an cathode and RVcoilprogrammed as an anode; LV3 programmed as an cathode and RVcoilprogrammed as an anode; or LV4 programmed as a cathode and RVcoilprogrammed as an anode. The IMD 16 may also be programmed to provideadditional vectors that include two or more cathodes and/or two or moreanodes. In some examples, one of the LV electrodes is programmed as acathode and the other three LV electrodes are programmed as anodes. Forexample, LV1 may be programmed as a cathode with LV2, LV3 and LV4programmed as anodes. In some examples, IMD 16 may utilize a vector thatincludes two anodes to two cathodes on the LV lead 20. For example, LV1and LV 2 may be anodes and LV3 and LV4 may be cathodes. In someexamples, the stimulation or sensing may be provided through one or moreof LV1-LV4 programmed as cathodes and with the can of IMD 16 functioningas an anode. In some examples, not shown, one of LV1-LV4 may beprogrammed as a cathode with an RVring electrode on RV lead 18programmed as an anode. The lead image 140, with the approximate spacingof the lead electrodes depicted, may help a physician or other clinicianvisualize the vectors resulting from a given electrode combination. Thismay help the physician to determine which of the numerous choices totest first.

In other examples, not shown, vector options may include a vectorbetween an RV tip electrode and an RV ring electrode or an RV tipelectrode and an RV coil electrode. The electrodes of RV may also formvectors with the can of IMD 16, or one or more electrodes on otherleads, including LV lead 20. The IMD 16 may include leads placed inareas not shown in FIG. 1, and these lead may also be graphicallyrepresented consistent with this disclosure.

Programmer 24 may display one of lead images 140 in response to theselection of a left ventricular lead from a list of leads via leadsection 116 and/or lead selection screen 118. FIG. 4A depicts Lead image140 a, which includes LV lead 20 a with LV1 and LV2 closely spaced nearthe tip of LV lead 20 a. LV3 and LV4, of LV lead 20 a, are also closelyspaced. The space between LV2 and LV3 is larger than the space betweenLV1 and LV2 and LV3 and LV4. In some examples, including the one shownin image 140 a, the space between the fourth electrode LV4 and the canmay not be accurately shown.

FIG. 4B depicts Lead image 140 b, which includes LV lead 20 b with LV1at the tip of lead 20 b. LV2 and LV3 are closely spaced together closerto IMD 16 b. The space between LV1 and LV2 is larger than the spacingbetween LV2 and LV3. LV4 is closer to the can of IMD 16 b than LV3 andthe space between LV3 and LV4 is greater than the space between LV2 andLV3. In some examples, the spacing depicted in image 140 may beapproximate. For example, the relative spacing between LV1, LV2, LV3 andLV4 may be accurate, while the spacing may not exactly equal the actualspacing of the electrodes on the lead 20 b that has been implanted inpatient 14.

FIG. 4C depicts Lead image 140 c, which includes LV lead 20 with LV1 atthe tip of lead 20 b. The spacing between LV1, LV2, LV3 and LV4 areapproximately equal. In some examples, the relative location of RVcoilon RV lead 18 c to the electrodes of LV lead 20 c may approximatelyequal to the spacing as the leads have been implanted within heart 12.

FIG. 4D depicts Lead image 140 d which includes LV lead 20 d with LV1and LV2 closely spaced near the tip of LV lead 20 d. The spacing betweenelectrodes LV2 and LV3 is approximately equal to the spacing betweenelectrodes LV3 and LV4. In some examples, the spacing depicted in image140 d may be approximate. For example, the relative spacing betweenLV1-LV4 may be accurate while the spacing may not exactly equal theactual spacing of the electrodes on the lead 20D that has been implantedin patient 14. In some examples, the lead may be depicted at multiple ofthe actual size for ease of visualization.

FIG. 5A is as schematic diagram illustrating an example lead image 150that may be displayed on user interface 98. Lead image 150 includes anIMD 16, a LV lead 20 and a RV lead 18. In the example shown LV lead 20is a quadripolar lead with electrodes LV1-LV4. In the example shown,electrode LV2 has been selected by a user to be an anode and electrodeLV3 has been selected by the user as a cathode. The selection may occur,for example, on parameters screen 130 or tests screen 138. In someexamples, the selection may occur when a selected lead image 150 isdisplayed on a programming interface. Lead image 150 shows thepolarities of the electrodes selected by the user.

FIG. 5B is a schematic diagram illustrating an example lead image 160that may be displayed on user interface 98. Lead image 160 includes anIMD 16, a LV lead 20 and a RV lead 18. In the example shown, LV lead 20is a quadripolar lead with electrodes LV1-LV4. In the example shown,electrode LV2 has been selected by a user to be an anode and electrodeLV 3 has been selected by a user to be a cathode. Lead image 160includes a depiction of the vector 162 created by electrodes LV2 andLV3. This depiction may help a user visualize if the electrodes selectedwill provide the stimulation desired.

FIG. 5C is a schematic diagram illustrating an example lead image 164that may be displayed on user interface 98. Lead image 165 includes anIMD 16, a LV lead 20 and a RV lead 18. In the example shown, LV lead 20is a quadripolar lead with electrodes LV1-LV4. In the example shown,electrode LV2 has been selected by a user to be an anode and electrodeLV 3 has been selected by a user to be a cathode. Lead image 164includes a depiction of an electrode field 166 created by electrodes LV2and LV3. This depiction may help a user visualize if the electrodesselected will provide the stimulation desired.

FIG. 6 is a flow diagram illustrating an example method of electrodeselection consistent with various examples in this disclosure. Aphysician or other user may interact with user interface 98 to selectlead(s) to program (170). The user may choose to program one or more ofthe leads that have been implanted in the patient 14 at a time. Forexample, a physician may desire to visualize both LV lead 20 and RV lead18 in order to depict the possibility of a vector between one or more ofthe electrodes of LV lead 20 and an electrode on RV lead 18.

The programmer 24 receives an indication of the lead type (172), e.g.,via the user interface. The indication of lead type may be received inthe form of a selection made by a user after the user has accessed theoptions provided by a lead selection screen 118. In some examples, leadselection screen 118 may depict approximate spacings of electrodes fromwhich a user may chose. In some examples, lead selection screen 118 mayinclude thumbnails of lead configurations corresponding to actual leads.In some examples, the thumbnails may be labeled to include a lead modelor serial number.

In some examples, programmer 24 may include a scanner, e.g., a barcodescanner, as part of user interface 98. The user may scan the barcode oranother identifying from the packaging of the lead that was implanted.The scanner may be able to read a machine readable code. In someexamples, the user may scan a barcode on a patient identification thatmay include information regarding the patient including the lead modelnumber for the implanted lead. In some examples programmer 24 mayreceive an indication of lead type (172) from IMD 16 via telemetryinterface 108.

Based on the indicated lead type, display 100 displays a lead imageassociated with the indicated lead type (174). In some examples, theprocessor 88 receives the indication of the lead type (172) form theuser interface 98 and accesses memory 90 to retrieve the lead image 92for display on display 100.

In some examples, the user selects electrodes (176) to be programmedbased on the lead image (174) on display 100. In some examples, theselection may be an initial vector to be tested. In some examples, thelead image may be updated to depict the electrodes that have beenselected. In some examples, the lead image may be displayed within otherdisplay screens, including the tests 128 screen or the parameters 130screen. This may allow a physician to continually visualize thestimulation that is being provided while changing various parameters ortesting the chosen electrode combination.

FIG. 7 if a flow diagram illustrating another example method consistentwith the present disclosure. An external programmer receives anindication of a lead type (180) that has been implanted in patient 14.As discussed above with respect to FIG. 6, the indication may come froma variety of sources, including user input, user selection from a listor other ordering of images stored within programmer 24 via scanner, orfrom the IMD 16 itself In response to the indication of lead type (180),processor 88 may retrieve the corresponding lead image for display (182)on user interface 98.

In some examples, after a lead image has been selected based on theindication of lead type and displayed on display 100, a user may modifylead electrode spacing (184). The modification of lead spacing (184) mayoccur in order to provide a better approximation of the electrodespacing configuration of the lead that has been implanted in patient 14.This may be helpful in instances where the programmer 24 does notinclude a lead image that exactly corresponds to the lead type indicatedor implanted. After a user is satisfied with electrode spacingconfiguration presented on display 100, a user may select electrodes(186) to test first. In some examples, the selection may be based onprevious experience by the user with the same type of lead and electrodespacing configuration. In some examples, the selection may be based onthe graphic presented. After a set of electrodes has been chosen, theuser sets program parameters (188). In some examples, the user mayaccess previous pacing programs 94 stored within memory 90. In someexamples, processor 88 may access the pacing programs 94 and present oneor more suggestions based on the electrodes selected by the user. Theprocesses of selecting electrodes and program parameters may be repeateduntil a combination of electrodes and pacing parameters provides thedesired effect.

Various examples have been described. These and other examples arewithin the scope of the following claims.

1. A system comprising: a user display; a memory configured to store aplurality of intracardiac lead images, each of the lead imagesassociated with a respective one of a plurality of lead types, and eachof the lead images including a plurality of electrodes spaced accordingto the spacing of electrodes of the associated lead type, an interfaceconfigured to receive an indication of which of the plurality of leadtypes corresponds to a lead of a patient; and a processor configured tochoose the one of the lead images that is associated with the indicatedlead type, and provide the chosen image to the user display for displayas part of a graphical user interface for programming cardiacstimulation therapy for the patient.
 2. The system of claim 1, whereineach of the intracardiac lead images include four electrodes.
 3. Thesystem of claim 1, wherein the interface comprises a user interfaceconfigured to allow a user to select which of a plurality ofintracardiac lead images from a pull-down or a pop-up screen correspondsto the lead of the patient.
 4. The system of claim 3, wherein the userinterface is configured to present thumbnails of the plurality ofintracardiac lead images, and allow the user to select which of aplurality of intracardiac lead images corresponds to the lead of thepatient.
 5. The system of claim 3, wherein the memory is configured tostore each of the lead images in association with a respective one of aplurality of model numbers, and the user interface is configured toallow the user to select which of a plurality of intracardiac leadimages corresponds to the lead of the patient based on the model numberassociated with the lead of the patient.
 6. The system of claim 1,wherein each of the plurality of lead types comprises a differentelectrode spacing configuration.
 7. The system of claim 1, wherein theinterface comprises a scanner configured to read a machine readable codethat indicates which of the plurality of lead types corresponds to thelead of the patient.
 8. The system of claim 1, wherein the graphicaluser interface for programming the cardiac stimulation therapy isfurther configured to allow the user to select one or more of theplurality of electrodes of the lead image for programming the cardiacstimulation therapy.
 9. The system of claim 1, wherein the graphicaluser interface for programming the cardiac stimulation therapy isfurther configured to allow the user to modify the spacing of theelectrodes of the selected lead image.
 10. The system of claim 1,wherein the interface comprises a scanner configured to read aradiofrequency identification tag that indicates which of the pluralityof lead types corresponds to the lead of the patient.